For the 2026 NMIBC Guidelines, new and relevant evidence was identified, collated and appraised through a structured assessment of the literature for all sections of the Guidelines. This resulted in the inclusion of 64 updated studies across the Guidelines. Key changes include:
- Update of Figure 4.1: Schematic representation of tumours according to the WHO 1973, WHO 2004/2022 grading systems and a three-tier and four-tier hybrid combination of the two systems.
- Update of the levels of evidence and recommendations in Section 4.10: Summary of evidence and recommendations for bladder cancer classification
- Update of the summary of evidence and recommendation on cystoscopy in Section 5.9: Summary of evidence and recommendations for the primary assessment of non-muscle invasive bladder cancer.
- Removal and adaption of recommendations in section 5.15: Summary of evidence and recommendations for TURB, biopsies and pathology report.
- Removal and adaption of the summary of evidence and recommendations in section 6.5: Summary of evidence and recommendations for stratification of NMIBC.
- Addition of two new tables summarising the treatment options for BCG-unresponsive tumours. Table 7.3 Papillary Ta/T1 and Table 7.4 Carcinoma in situ ± papillary.
- Addition of a new recommendation relating to the addition of sasanlimab and durvalumab to Bacillus Calmette-Guérin (BCG) with maintenance in selected BCG-naive patients with high and very high-risk NMIBC in Section 7.10: Recommendations for adjuvant therapy in TaT1 tumours and for therapy of carcinoma in situ.
- Update of Table 7.5: Treatment options for the various categories of BCG failure.
- Removal and adaption of the recommendations in Section 8.2: Summary of evidence and recommendations for follow-up of patients after TURB for NMIBC.